Mutual Aid COVID-19 Support Request
Brave Space Alliance will be operating a crisis food pantry for Black and Brown queer and trans folks in Chicago during the COVID-19 Pandemic. DELIVERIES WILL NOT BE MADE TO ADDRESSES OUTSIDE OF CHICAGO. If you would like food and/or hygiene supplies dropped off at your front door, please use this form. We are prioritizing folks who are sick, disabled, quarantined without pay, elderly, undocumented Black, Brown, or Indigenous. PLEASE DO NOT SUBMIT MORE THAN ONE SUPPORT REQUEST AT A TIME, WE WILL ONLY HONOR ONE. If more supplies are needed please wait until the following week to submit a new request.
Name (First and Last) *
Your answer
Full Address (include Apartment Number) *
Your answer
Zip Code *
Your answer
Gender (ex: female, male, non-binary, trans, etc.) *
Your answer
Sexuality (ex: queer, gay, lesbian, pansexual, asexual, etc.)
Your answer
Ethnicity (ex: African American, Latinx, Native American, Nigerian, etc.) *
Your answer
Race (ex: Black, Brown, White, Asian/Pacific Islander, etc.) *
Your answer
Phone Number (this number will be used to notify you when your delivery has arrived) *
Your answer
Number of People in the Household *
Your answer
Dietary Restrictions *
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